Coronary Heart Disease Risk Factors - Part II
Emerging Potential Risk Factors
In order for any emerging risk factor to be useful, there are two requirements:
There needs to be as high as possible a ratio between the highest and the lowest risk determined by this factor.
It needs to be independent of exsisting risk factors.
Regarding item 1, if the ratio is low - e.g., 1.1, it doesn't make any practical difference whether your absolute risk is 10% or 11%, 50% or 55%. If the ratio is high - e.g., 4, there is a significant difference between a risk of 10% and of 40%. With 10%, one might consider a "wait and see" approach, whereas with 50%, a more proactive approach is usually called for.
Regarding item 2, what we need to be sure is that the factor supplies additional information. In other words, if the new factor is high every time LDL is high, and low every time LDL is low, and with the same relative risk, we might as well only do one of the tests. We can infer one from the other. However if the new factor can either be high or low, regardless of LDL (or any other risk factor), it provides additional discrimination concerning the overall risk.
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